Provider Demographics
NPI:1619183597
Name:RAVI GORAV MD PA
Entity Type:Organization
Organization Name:RAVI GORAV MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:GORAV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-522-7982
Mailing Address - Street 1:2540 S TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4907
Mailing Address - Country:US
Mailing Address - Phone:575-522-7982
Mailing Address - Fax:575-522-7987
Practice Address - Street 1:2540 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4907
Practice Address - Country:US
Practice Address - Phone:575-522-7982
Practice Address - Fax:575-522-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0274207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty